Influencing factors for hemolytic anemia in patients with chronic hepatitis C treated by ribavirin combined with pegylated interferon-α

Objective To investigate the influencing factors for ribavirin ( RBV) -induced hemolytic anemia during the treatment of chronic hepatitis C using RBV combined with pegylated interferon-α ( PEG-IFNα) , and to provide a reference for early prediction of RBV-related hemolytic anemia in clinical practice. Methods A total of 235 patients with chronic hepatitis C who were given antiviral therapy with PEG-IFNα combined with RBV in Beijing YouAn Hospital from March 2016 to March 2018 were enrolled. Parameters of routine blood test, liver function parameters, liver stiffness measurement, HCV RNA, HCV viral genotype, and inosine triphosphate pyrophosphatase ( ITPA) genotype were determined before the antiviral therapy, and routine blood tests were performed at weeks 2, 4, 8, and 12 of treatment. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for non-normally distributed continuous data between groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups. Univariate analysis and multivariate logistic regression analyses were used to determine the influencing factors for RBV-related hemolytic anemia, and a predictive model was established accordingly; the receiver operating characteristic curve was used to analyze the predictive value of this model for RBV-related hemolytic anemia. Results At weeks 2, 4, 8, and 12 of treatment, the ITPA ( rs1127354) genotype CC group had a significantly greater reduction in hemoglobin ( Hb) than the ITPA ( rs1127354) genotype AA + AC group ( all P < 0. 05) . At week 4 of treatment, there was a significant difference between the AA + AC group and the CC group in the proportion of patients with a > 30 g/L reduction in Hb ( 2. 38% vs 39. 9%, X2= 23. 175, P < 0. 001) or an Hb level of < 100 g/L ( 0 vs10. 88%, P = 0. 018) . The degree of reduction in Hb at week 2 ( odds ratio ( OR) = 1. 073, P < 0. 001) , ITPA ( rs1127354) genotype ( OR = 18. 920, P = 0. 005) , and baseline Hb level ( OR = 1. 032, P = 0. 024) were independent risk factors for a > 30 g/L reduction in Hb at week 4. Conclusion Patients with ITPA ( rs1127354) genotype CC tend to develop RBV-related hemolytic anemia. ITPA ( rs1127354) genotype, baseline Hb level, and degree of reduction in Hb at week 2 can be used to predict the development of RBV-related hemolysis during anti-HCV treatment, in order to achieve early warning and guide early intervention.